Neurotoxicity and the need for anesthesia in the newborn: Does the emperor have no clothes?

In 2011 nearly half the pediatric papers in Anesthesiology were related to neurotoxicity of general anesthetics to the developing brain. There is continued debate about the clinical relevance of the animal data, and the interpretation of human cohort studies. In this issue Shih et al. present a paper that moves us a significant step closer to translating the animal data to clinical situations.1 But, as we slowly unravel the question of whether or not general anesthetics cause any clinically significant effect on brain development, we should perhaps address some wider-related issues that sometimes go unsaid.

“… regardless of whether or not sevoflurane causes any clinically relevant toxicity, is it time to question the mantra that all babies need a hypnotic agent such as sevoflurane?”